M.Com. (Economics) / Access to health care is a basic human right in South Africa. Primary health care is viewed by the South African government as the means to improving access to health care in the country. The concept of primary health care is based on the importance of first contact with a primary health worker. The Department of Health introduced free primary health care because it believes that the most significant barrier to access to health care is poverty. When a service is provided for free there is no income generated from user fees and the issue of funding becomes very important. This study performs an analysis of the free primary health care programme in South Africa and how it is financed. An important feature that characterizes South Africa is high inequality which is reflected in the high level ofpreventable diseases as well as high incidents of chronic diseases. The implementation of free primary health care has led to improved access to health care and somewhat improved the health status of the South African population. In order to address the inequalities in the health sector there must be funding targeted towards the needs of the poor. Government's fiscal policy places limits on the expansion of public expenditure, which poses a strain on resources flowing to the health sector. In addition to that there has not been a significant shift of funds from higher levels of care to primary health care. The funding issue will need to be urgently resolved for primary health care to be sustainable...

The human immunodeficiency virus/acquired immune-deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. “AIDS, (Acquired Immune Deficiency Syndrome), has devastated the social and economic fabric of African societies, made orphans of a whole generation of children and become the epicentre of the HIV/AIDS pandemic” (Fassin, 2007: 76). Like the virus itself, the AIDS crisis mutates rapidly. Children who are AIDS orphans living in South Africa, as in other African countries, suffer from recurrent psychological trauma. It starts with the illness and death of their parents and is followed by cycles of poverty, malnutrition, stigma, exploitation, sickness and often sexual abuse. The figures concerning those affected, which are staggering, offer various predictions regarding the number of orphans left in the wake of the pandemic. Between 1990 and 2003, the number of orphaned children rose from fewer than 1 million to more than 12 million in sub-Saharan Africa (UNICEF, 2005: 68). South Africa is severely affected by the AIDS pandemic, with the largest number of HIV infections in the world, a total of 5.7 million (RSA, 2010: 10), affecting approximately 3.2 million women and 280 000 children aged from 0 to14 years. There is a significant variation in HIV prevalence per province, with the Eastern Cape (EC) reportedly having an average prevalence rate of 28 percent. Hence South Africa is likely to be the country with highest percentage of children orphaned by AIDS within its population. Orphanhood is a major consequence of the AIDS pandemic in South Africa with an estimated 2.2 million AIDS-orphaned children, 11,188 per 100,000 by 2015. Most children who are AIDS orphans living in township communities live predominantly uncared for and unsupported. Therefore the purpose of this research study was to develop strategies to provide care and support to children who are AIDS orphans living in township communities. To achieve the purpose of this research study, a qualitative, exploratory, descriptive and contextual design was used by the researcher to gain insight from health and social care practitioners who render care and support to children who are AIDS orphans living in these communities. The data from in-depth interviews with the health and social care practitoners was used by the researcher to develop strategies to provide care and support to children who are AIDS orphans living in township communities. The study comprised the following four phases: Phase One: During this phase, the researcher will present an overview of the current legislative framework policies at an international, national and provincial level, regarding the the rights of children living in South Africa. Phase Two: During this phase data from two research populations were collected and analysed. As the research process of this study dealt with two groups of participants, namely in group one health care practitioners and group two comprised social workers and psychologists, who work in the township communities to provide care and support to children who are AIDS orphans living in these communities. The researcher discussed each group separately in the discussion of phase two of the study. Phase Three: Comprised the themes identified in the data gathered from the transcribed in-depth interviews, the field notes as well as the reflective journals were cross-validated to ensure trustworthiness of the data which was then organised into a conceptual framework. The conceptual framework was used to clarify the relationships of the concepts and the themes identified during the research process and also used to link the gathered data to previously established models and theories (Schneider, 2004: 133). Phase Four: The last phase of the research design, focused on the development of the “Steps of progression strategies” to provide holistic care and support to children who are AIDS orphans living in township communities. This was done making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008: 237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, simple, applicable and significant to nursing practice have been developed for use by the Department of Health and Department of Social Development as well as primary health and social care practitioners to provide holistic care and support to children who are AIDS orphans living in township communities in South Africa.

The world population is ageing, and this is also relevant to South Africa. At the same time the potential support ratio (the number of persons aged 15 to 64 years per one older person aged 65 years or older) is falling, and the dependency burden on potential workers increases. To alleviate the financial burden on the aged, and their families, it has become necessary to develop a financial plan to cover the cost of frail care. The overall purpose of this research is to determine whether any financial plans exist which are relevant. If nothing existed, a plan had to be developed. The research methodology for this study comprised the following steps: Firstly, the demographics of the world and South Africa were researched. The concept of frail (long-term) care in the United States of America and New Zealand was investigated to determine what is available. The subsidisation concept of the South African Government towards caring for the elderly was also investigated. Secondly, a questionnaire was sent to the residents of five retirement complexes in George to determine their interest in such a plan. The records of the frail care unit that these residents utilise were analysed to determine the number of residents needing frail care. A comparative study of the cost of frail care in the Southern Cape was undertaken. Thirdly, two options to partly subsidise the cost of frail care were examined, where the first option covers the running cost, and the second option, subsidising one third of the frail care cost, builds up a sustainable fund after the first five year period. The funds of the second option can then be utilised in the subsequent years to increase the subsidisation portion of frail care cost. The final step of this study entailed the formulation of recommendations to implement the frail care nursing levy as soon as possible, with special attention given to the following: a) It must be compulsory for new residents to join the fund. b) A yearly capital amount of R100 000 or more is needed to sustain the fund. c) A contract must be drafted to set out all the rules and regulations to the residents. d) An attitude change amongst some residents is required. Individuals must realise that the success of this plan depends upon themselves and with the necessary support could make a significant contribution towards their own peace of mind if and when frail care is needed.

Thesis (MFamMed)--Stellenbosch University, 2015. / Introduction Since 1994 the South African health care system has been undergoing considerable transformation as new health challenges emerges locally and globally. Limpopo and Mopani primary healthcare in particular is not an exception. The information on the reasons for encounter and diagnosis in primary care will create an opportunity to focus on proper planning for the delivery of quality health care that is relevant to the people, socially justifiable and cost effective. The study aimed to determine the range and prevalence of reasons for encounter and diagnoses found among patients attending primary care facilities in Limpopo. Methods Design: A prospective cross-sectional survey Setting: Primary health care centers, clinics and mobile clinics in Mopani district of Limpopo Province, South Africa. Selection of facilities, primary care providers and patients: Patient encounters were obtained from twenty-nine randomnly selected primary care facilities by trained primary care practitioners with data collection sheets. Data collection: The data collection days were spread across all days of the week and across the whole period from July 2009 to March 2010. Analysis: The international classification of primary care (ICPC-2) was used to code and analyse the data. Results A total of 6,666 patient encounters were recorded. Females 4598 (69%), accounted for more than two thirds of all contacts and children aged 0-4 years were the largest age group. Overall the commonest reasons for encounter were cough (13.0%), repeat family planning (8.4%) and headaches (5.7%). The commonest diagnoses were cough/upper respiratory tract infection (16.9%), hypertension (5.7%) and HIV/AIDS (2.6%). The top 20 reasons for encounter (RFE) and diagnoses are presented for all patients, men and women as well as children < 5 years. Conclusion Primary care nurse practitioners, clinical associates and general medical practitioners need to be competent to assess and manage the common RFE and diagnoses in order to deliver comprehensive health care at the primary level. / AFRIKAANSE OPSOMMING: Nie beskikbaar

It is generally accepted that a business operates more efficiently when it is able to consolidate information from a variety of sources. This principle applies as much in the healthcare environment. Although limited in the South African context, the use of electronic systems to access information is advancing rapidly. Many aspects have to be considered in regards to such a high availability of information, for example, training people how to access and protect information, motivating them to use the systems and information extensively and effectively, ensuring adequate levels of security, confronting ethical issues and maintaining the availability of information at crucial times. This is especially true in the healthcare sector, where access to critical data is often vital. This data must be accessed by different kinds of people with different levels of access. However, accessibility often leads to vulnerabilities. The healthcare sector deals with very sensitive data. People’s medical records need to be kept confidential; hence, security is very important. Information of a very sensitive nature is exposed to human intervention on various levels (e.g. nurses, administrative staff, general practitioners and specialists). In this scenario, it is important for each person to be aware of the requirements in terms of security and privacy, especially from a legal perspective. Because of the large dependence on the human factor in maintaining information security, organisations must employ mechanisms that address this at the staff level. One such mechanism is information security education, training and awareness programmes. As the learner is the recipient of information in such a programme, it is increasingly important that it targets the audience that it is intended for. This will maximize the benefits achieved from such a programme. This can be achieved through following a role-based approach in the design and development of the SETA programme. This research therefore proposes a model for a role-based SETA programme, with the area of application being in the South African healthcare environment.

Health is a basic human right enshrined in the South African Constitution. It is the responsibility of government to ensure that the nation is healthy because good health is a prerequisite for social and economic development as well as an outcome of that process. Special attention on the healthcare needs of rural communities should be given because these communities were the worst affected by the legacy of the apartheid regime. Moses Mabida community is no exception. Since the advent of democracy, work has been done to ensure that adequate primary health care services are delivered to previously disadvantaged communities such as Moses Mabida. To monitor progress on health care service delivery, evaluation of these services is needed. The evaluation of these services will help identify the strengths and weaknesses so as to come up with quality improvement strategies, hence this study. This study takes form of an assessment survey involving a literature review and a survey of members of the Moses Mabida community who depend on the clinic for their health care needs. The literature identified best practice models of primary health care and these were used as an analytic tool to determine to what extent the primary health care services at Moses Mabida comply with national and international standards. It has been shown that the primary health care services at Moses Mabida Clinic largely comply with national and international standards although several recommendations have been presented for consideration.

M.Com. (South African & International Taxation) / The tax system in South Africa makes provision for everyday South African citizens to contribute to a greater or lesser extent towards health care funding in South Africa. However, as a result of the high unemployment rate, a large gap exists between tax contributors and non-tax contributors. This raises the question of whether it is fair that the burden to fund the proposed National Health Insurance (NHI) initiative in South Africa is borne by the small percentage of current tax contributors. The purpose of this research was to provide a taxation perspective on the different funding models and financing options available to the South African government for consideration in developing the NHI implementation strategy. The study evaluated the four traditional health care models used worldwide and assessed existing health care systems in selected first and third world countries in order to contribute towards the development of the proposed NHI system in South Africa. The health care models used by France, The United States, The United Kingdom, Brazil and Spain were evaluated in order to achieve an understanding of the funding approaches followed by these countries. It was found that although it is inevitable that South African tax contributors will have to be more heavily taxed in order to fund the NHI, as there are only limited possibilities for distributing the tax burden evenly. The main stumbling block in finding an equitable funding solution is the fact that there is a large disparity in South African income tax contributors.

M.Comm. / Health care is recognised as a basic human right. The current position of private health care in South Africa is of great concern. Not only is health care almost unaffordable but the future quality of health care also causes great concern. With this in mind it is obvious that alternatives to conventional medical aids and health insurance are necessary to guarantee the continued availability of quality medical care to the South African public. Most people would agree that our private sector health care system is characterised by a depressing history of inadequate planning, control and management. It is for this reason that amendments to the Medical Schemes Act were considered necessary. Certain of these amendments will extend the role played by medical schemes in the management of health care resources. This will result in the traditional boundaries and relationships between the public, health professionals and health care facilities, and the financiers in our private health care system being altered. A new philosophy will evolve based on open and participative practices, as well as increased coordination, integration and cooperation (Veliotes et al, 1993: 12). Internationally, the health care objectives of most countries are to provide access to highquality care for all the people, and to provide this care efficiently and effectively. In the last decade the task of achieving these potentially conflicting objectives has become more difficult. At present, private health care is funded by medical schemes, health insurance companies, employers and individuals themselves. Neither medical aids nor health insurance companies are able to contain the rise in health care cost, which has led to the emergence of a new method of finding, namely Managed Health Care (MHC). Health care cost has accelerated at a rate far above the consumer price index(CPI). Rising health care costs in the private sector have been blamed on structural inefficiencies in the medical aid system. While patients have little incentive to minimise care expenditure, providers have an incentive to overuse the system.

M.Com. (Business Management) / It is a well established fact that the majority of South Africans do not have access to health of a satisfactory quality, and that many have almost no effective access to health care at all. Health care in South Africa today can be characterised as being both inequitable and inefficient. It is inequitable as particular groups enjoy privileged access to health care, whereas others do not have any access at all and it is inefficient because of the existence of over treatment in the private sector and fragmentation in the public sector (Picard, 1992:1). In 1987, according to the best calculations available, South Africa spent R9,2 billion on health care. This figure amounted to 5,8 percent of the Gross National Product (GNP) for that year (De Beer & Broornberg, 1990:1). The private sector accounted for 44 percent of expenditure that year, yet supplied health care to 20 percent of the South African population. On the other hand, the remaining 80 percent of the population had to rely on the public sector where just 56 percent of the total expenditure was located (De Beer & Broornberg, 1990:1). It is clear that the pUblic sector is unable to provide adequate health care for 80 percent of the population on the money presently available. This inability to provide services in the public sector has arisen from fragmentation and duplication of facilities, excessively bureaucratic management structures, undue emphasis on expensive curative care, high technology tests and interventions at the expense of providing basic health services. In addition to this, the public sector has been significantly underfunded. This can be supported by the above figures that show that 3,3 percent of the GNP is spent on public sector health care and this figure is well below the 5 percent target set by the World Health Organisation as a minimum standard ,(De Beer & Broomberg, 1990:1).

Although open to debate, it is something of an undisputed fact and has been since the days of Florence Nightingale, that hospital management is frustrated with recurring problems - many of them due to broken processes. Hospitals are places of phenomenal healing and heroic care. However, as with any human-led endeavour, there are problems. (Grunden (2009)) A first time use of the word ‘lean’ generally begs some explaination as it is not a commonly used word. The simplest way to explain the word is by way of the introduction of the concept known as ‘lean management’. Lean management is a methodology which allows hospitals to advance the quality of patient care by reducing errors and waiting times. Lean is a system of reinforcement of hospital business for the long term thereby reducing costs and risk. Kanban (2009) states that lean is a toolset; a management system and a viewpoint that can change the way hospitals are structured and managed. Lean helps managers to comprehend and identify broken systems and to improve these in small parts, while employees aid in finding solutions for broken systems. This proposal analyses the effect lean tools have had within Arwyp Medical Centre in Kempton Park, South Africa.